Provider Demographics
NPI:1922066042
Name:COPPIN, ERIN V (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:V
Last Name:COPPIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10011 CENTENNIAL PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4156
Mailing Address - Country:US
Mailing Address - Phone:801-545-8480
Mailing Address - Fax:801-545-8495
Practice Address - Street 1:10011 CENTENNIAL PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4156
Practice Address - Country:US
Practice Address - Phone:801-545-8480
Practice Address - Fax:801-545-8495
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004970363A00000X
UT7113001-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAQ67311Medicare UPIN
UT000065544Medicare PIN
WAAB11720Medicare ID - Type UnspecifiedGROUP #
P00691511Medicare PIN